How I Deal With... SVGs

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How I Deal With...SVGs

• Simon Redwood
• St Thomas

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• No Conflict of Interest to Declare

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• Mr PM, 55 years old
• CABG 1993
• SVG LAD
• SVG OM2
• 8F LCB

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How should we tackle this?
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Laser Catheter
0.9, 1.4. 1.7. 2.0 mm diameter
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Particle Size post 308 nm ablation
5 gt 5 - lt12 micron
50 lt 1 micron
45 1 5 micron
Erytrocyte 7µ
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Saline Infusion Protocol
In order to obtain an optimal contact between
catheter tip and lesion it is mandatory to
implement the saline infusion protocol. 15-20 ml
saline bolus after each contrast injection 15-20
ml saline flush during every laser activation (5
sec)
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Saline Infusion
Images taken from the DVD Critical Limb
Ischemia, New Techniques For Complex
Interventions, Prof. Dr. Giancarlo Biamino - Dr.
Dierk Scheinert (Herzzentrum Leipzig) Michael
Jaff, MD (Lennox Hill, NY)
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• Luge
• 2.0c laser

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• 5x28 to mid lesion
• 5.0x20 proximal
• 5.0x15 Quantum

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Peak CK 194
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• Mr JN, 64 years old
• CABG 1988
• LIMA LAD
• SVG RCA and LCx
• Tn ve ACS
• Anterolat ST changes
• LIMA LAD normal
• SVG RCA occluded

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• Continued pain with ECG changes
• BP 80 systolic

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• 8F HS
• IABP
• Luge

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• 2.0c laser

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• Filterwire

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• 4.0x20 distal
• 4.0x28 prox
• 4.0 post dilatation

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Peak CK 14
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• Mrs DC, 72 years old
• CABG 1999
• LIMA-LAD
• SVG-OM1 and RCA
• Tn ve ACS (gt2)
• Infero-lat ST depression

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• Luge
• 2.0c laser

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• Filterwire
• 4.5x28 distal

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• 4.5x24 prox

Peak CK 205
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Summary

• Conventional wire
• Debulk with laser
• Filter device
• Stent usually BMS, occ. covered